Chapter 48 Liver, Bilary Tract, and Pancreas Part 2 Flashcards
What position should the patient be in to manage increased intracranial pressure?
Head elevated at 30 degrees
This position helps reduce intracranial pressure.
What should be avoided to prevent increased intracranial pressure?
Excessive patient stimulation and straining maneuvers
Straining or Valsalva-like movements can increase ICP.
What is crucial to monitor regularly in patients with increased intracranial pressure?
Baseline level of consciousness and orientation
Changes should be reported to the healthcare provider.
Why should sedatives be avoided in patients with increased intracranial pressure?
They may confuse effects with worsening encephalopathy
Sedatives can affect mental status.
What is the recommended use of benzodiazepines in patients with liver issues?
Use only minimal doses due to delayed metabolism
The failing liver affects drug metabolism.
What is essential to monitor for renal function in patients with increased intracranial pressure?
Intake and output
This helps assess kidney function.
What types of cancer are most common in the liver?
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma
These are primary types of liver cancer.
How many cases of liver cancer were reported in the United States in 2018?
About 42,220 cases
This includes approximately 30,200 deaths.
What is the most common cause of death in patients with cirrhosis?
Liver cancer
Cirrhosis is often caused by HCV.
What percentage of patients with cirrhosis develop liver cancer each year?
About 2%
This statistic highlights the risk associated with cirrhosis.
What are the common clinical manifestations of late-stage liver cancer?
Fever/chills, jaundice, anorexia, weight loss, palpable mass, RUQ pain
These symptoms may indicate advanced disease.
What diagnostic tests are used for liver cancer?
Ultrasound, CT, MRI
MRI advancements allow accurate diagnosis without biopsy.
What is a potential risk associated with liver biopsy?
Bleeding and tumor cell seeding along the needle tract
Biopsy carries inherent risks.
What is the significance of serum a-fetoprotein (AFP) levels in liver cancer?
High rate of detection of early-stage HCC when combined with ultrasound
AFP is a tumor marker for liver cancer.
What is the primary focus of liver cancer prevention?
Identifying and treating chronic HBV and HCV infections
Addressing chronic alcohol use also lowers risk.
What factors influence the treatment plan for liver cancer?
Stage of cancer, number, size, location of tumors, blood vessel involvement, patient age, overall health, extent of liver disease
These factors determine treatment options.
What offers the best chance for a cure in liver cancer patients?
Liver resection (partial hepatectomy)
Only 15% have enough healthy liver tissue for this option.
What non-surgical therapies are available for liver cancer?
Percutaneous ablation, chemoembolization, radioembolization, systemic therapies
These treatments may be used when surgery is not an option.
In ablation therapy, what can be injected into the tumor?
Ethanol, acetic acid
Various substances are used to destroy the tumor.
What are the common procedures for liver cancer treatment?
Percutaneous, laparoscopic, or open incision procedures
These procedures are limited by the number, size, and location of liver tumors.
What is the usual treatment option for patients with multinodular HCC or intermediate-stage liver cancer?
Embolization of tumors, specifically TACE or TARE
TACE stands for transarterial chemoembolization, and TARE stands for transarterial radioembolization.
What does TACE do?
Shuts off blood supply to tumors and exposes tumor cells to chemotherapy drugs
What does TARE do?
Destroys tumors by slowly releasing radioactive material directly to the tumor site
What are systemic therapy options for liver cancer?
Chemotherapy and immune-based therapies, such as monoclonal antibodies, tyrosine kinase inhibitors, and immune checkpoint inhibitors
What is the prognosis for patients with liver cancer?
Poor, but improving with early screening and surveillance programs
What are potential complications of untreated liver cancer?
Death within 6 to 12 months, often from hepatic encephalopathy or massive GI bleeding
What is the leading reason for liver transplantation?
Liver disease related to errors of metabolism, specifically NAFLD
What is the process for evaluating liver transplant candidates?
Rigorous transplant evaluation including physical assessment, laboratory tests, and psychological testing
What are some contraindications for liver transplantation?
Severe extra-hepatic disease, advanced HCC, ongoing drug or alcohol use
What types of livers can be used for liver transplantation?
Deceased (cadaver) and live donor livers
What are the risks associated with live liver donation?
Biliary problems, hepatic artery thrombosis, wound infection, postoperative ileus, pneumothorax
What is a split liver transplant?
When a liver is divided into 2 parts and implanted into 2 recipients
What are common postoperative complications of liver transplantation?
Bleeding, infection, and rejection
What is the standard immunosuppressive therapy after liver transplantation?
Combination of corticosteroids, a calcineurin inhibitor (cyclosporine or tacrolimus), and an antiproliferative agent (e.g., azathioprine)
Which immunosuppressive agent is superior in liver transplants?
Tacrolimus
What percentage of patients live more than 5 years after liver transplant?
About 80%
What factors influence long-term survival after liver transplantation?
Cause of liver failure, such as localized HCC, chronic HBV or HCV, biliary disease
What treatment reduces reinfection rates in liver transplant patients with HBV?
IV HBIG and a nucleoside or nucleotide analog
What is the role of DAAs in HCV-positive liver transplantation?
They can cure HCV infection and provide the opportunity to use HCV-positive liver grafts
What is critical nursing care after liver transplantation?
Monitoring electrolyte levels, neurologic status, urine output, and signs of bleeding, infection, and rejection
What are common respiratory problems after liver transplantation?
Pneumonia, atelectasis, and pleural effusions
What is a key sign of infection in post-liver transplant patients?
Fever may be the only sign of infection
What is acute pancreatitis?
Acute inflammation of the pancreas characterized by spillage of pancreatic enzymes into surrounding tissue, causing autodigestion and severe pain.
What are the common etiologic factors for acute pancreatitis?
- Alcoholism
- Biliary tract disease
- Trauma
- Infection
- Drugs
- Postoperative GI surgery
- Unknown
What is the most common cause of acute pancreatitis in the United States?
Gallbladder disease (gallstones)
What is the second most common cause of acute pancreatitis?
Chronic alcohol use
What are some less common causes of acute pancreatitis?
- Drug reactions
- Pancreatic cancer
- Hypertriglyceridemia (serum levels over 1000 mg/dL)
What is the primary pathogenic mechanism in acute pancreatitis?
Autodigestion of the pancreas due to injury or activation of pancreatic enzymes within the pancreas
What can cause obstruction of pancreatic ducts leading to pancreatitis?
Blockage created by gallstones
What are the two types of pathophysiologic involvement in acute pancreatitis?
- Mild pancreatitis (edematous or interstitial pancreatitis)
- Severe pancreatitis (necrotizing pancreatitis)
What risk factors are associated with severe pancreatitis?
- Permanent decreases in pancreatic endocrine and exocrine function
- High risk for pancreatic necrosis, organ failure, and septic complications
What is the overall fatality rate associated with severe pancreatitis?
9%
What is the main clinical manifestation of acute pancreatitis?
Abdominal pain
Where is the abdominal pain typically located in acute pancreatitis?
Usually in the left upper quadrant
True or False: The liver’s size and metabolic breakdown of drugs increase with age.
False
What happens to the liver’s capacity to respond to injury as people age?
It decreases
What is the significance of drug-induced liver injury (DILI) in older adults?
Older adults are particularly vulnerable due to multiple medications and decreased liver function.
What chronic conditions can contribute to liver disease in older adults?
- Chronic alcohol use
- Obesity
What can variceal bleeding in older adults with liver disease cause?
Significant morbidity and mortality requiring immediate medical intervention
What condition may be misdiagnosed as dementia in older adults with liver disease?
Hepatic encephalopathy
Fill in the blank: Transplanted livers take longer to _______ in the older adult.
[regenerate]
Why might older adults not be good candidates for liver transplants?
Increased risks for complications due to comorbid conditions
What effect does chronic alcohol use have on pancreatic enzyme production?
It is thought to increase the production of digestive enzymes in the pancreas.
What is a common symptom of pancreatitis that often radiates to the back?
Severe, deep, piercing abdominal pain
The pain often has a sudden onset and worsens with eating
What are some accompanying symptoms of pancreatitis?
- Nausea and vomiting
- Low-grade fever
- Leukocytosis
- Hypotension
- Tachycardia
- Jaundice
Abdominal tenderness with muscle guarding is also common
What signs may indicate severe pancreatitis related to intravascular damage?
- Cyanosis
- Greenish to yellow-brown discoloration of the abdominal wall
- Grey Turner spots (bluish flank discoloration)
- Cullen sign (bluish periumbilical discoloration)
These signs result from seepage of bloodstained exudate from the pancreas
What can cause shock in patients with pancreatitis?
- Bleeding into the pancreas
- Toxemia from activated pancreatic enzymes
- Hypovolemia due to fluid shift into the retroperitoneal space
Massive fluid shifts can lead to shock
What is a pancreatic pseudocyst?
An accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates surrounded by a wall next to the pancreas
Manifestations include abdominal pain, palpable epigastric mass, nausea, vomiting, and anorexia
What diagnostic imaging tests are used to detect a pancreatic pseudocyst?
- CT scan
- MRI
- Endoscopic ultrasound (EUS)
Cysts usually resolve spontaneously but can perforate, causing complications
What is a pancreatic abscess?
An infection resulting from extensive necrosis in the pancreas
It can rupture or perforate into adjacent organs and requires prompt surgical drainage
What systemic complications can arise from acute pancreatitis?
- Cardiovascular complications
- Pulmonary complications (pleural effusion, atelectasis, pneumonia, ARDS)
Pulmonary complications arise from enzyme-induced inflammation of the diaphragm
What laboratory tests are primarily used for diagnosing acute pancreatitis?
- Serum amylase
- Serum lipase
Serum amylase is usually high early and remains elevated for 24 to 72 hours
What other serum findings are associated with acute pancreatitis?
- Increased liver enzymes
- Increased triglycerides
- Increased glucose
- Increased bilirubin
- Decreased calcium
These findings support the diagnosis of acute pancreatitis
What imaging test is considered the best for pancreatitis and its complications?
CT scan
It is effective in identifying pseudocysts and abscesses
What are the goals of interprofessional care for acute pancreatitis?
- Pain relief
- Prevent or alleviate shock
- Reduce pancreatic secretions
- Correct fluid and electrolyte imbalances
- Prevent or treat infection
- Remove the precipitating cause
These goals guide the management of acute pancreatitis
Fill in the blank: Tetany in severe pancreatitis can be caused by _______.
[hypocalcemia]
It is related to the combining of calcium and fatty acids during fat necrosis
True or False: Patients with severe acute pancreatitis are at risk for abdominal compartment syndrome.
True
This condition can arise from intraabdominal hypertension and edema
What is the mechanism of action of antacids?
Neutralize gastric hydrochloric (HCI) acid secretion.
What diagnostic assessments are used for acute pancreatitis?
- History and physical assessment
- Serum amylase and lipase
- Blood glucose
- Serum calcium
- Serum triglycerides
- Flat plate of the abdomen
- Abdominal ultrasound
- Endoscopic ultrasound (EUS)
- MRCP
- ERCP
- Contrast-enhanced CT of pancreas
- Chest x-ray
What role do antispasmodics play in the treatment of acute pancreatitis?
They affect vagal stimulation, motility, and pancreatic outflow.
What is the purpose of carbonic anhydrase inhibitors like acetazolamide in pancreatitis treatment?
They influence pancreatic secretion.
What is the role of morphine in managing acute pancreatitis?
Pain relief.
What do PPIs like omeprazole do in the context of pancreatitis?
Suppress HCl acid secretion.
What is the management protocol for a patient with acute pancreatitis?
- NPO with NG tube to suction
- Albumin if shock is present
- IV calcium gluconate (10%) if tetany is present
- Lactated Ringer’s solution
What is the purpose of administering insulin in chronic pancreatitis?
Treat diabetes or hyperglycemia, if needed.
What are pancreatic enzyme products used for in chronic pancreatitis?
Replacement therapy for pancreatic enzymes.
What is the focus of conservative therapy for pancreatitis?
Supportive care including aggressive hydration, pain management, and minimizing pancreatic stimulation.
True or False: Antibiotics are always necessary in the treatment of acute pancreatitis.
False.
What is the significance of monitoring serum glucose levels in patients with severe pancreatitis?
To check for hyperglycemia.
What surgical therapy may be performed if acute pancreatitis is related to gallstones?
Urgent ERCP plus endoscopic sphincterotomy.
What is the purpose of laparoscopic cholecystectomy in the context of pancreatitis?
Reduce the potential for recurrence of pancreatitis.
What is essential to do when treating acute necrotizing pancreatitis?
Prevent and treat infections.
What is the initial dietary recommendation for a patient with acute pancreatitis?
NPO to reduce pancreatic secretion.
Fill in the blank: The inflamed and necrotic pancreatic tissue is a good medium for _______.
bacterial growth.
What should be monitored if a patient receives IV lipids during pancreatitis treatment?
Blood triglyceride levels.
What is the recommended approach to feeding as pancreatitis resolves?
Start with small, frequent feedings.
What type of diet is recommended for patients with acute pancreatitis?
High in carbohydrate content
This type of diet is less stimulating to the exocrine part of the pancreas.
What symptoms may indicate an intolerance to oral foods in a patient with acute pancreatitis?
Pain, increasing abdominal girth, increased serum amylase and lipase levels
These symptoms help in assessing the patient’s tolerance to food.
What may be given to patients with acute pancreatitis to supplement their diet?
Fat-soluble vitamins
These vitamins may be necessary due to malabsorption issues.
What important health information should be assessed in a patient with acute pancreatitis?
Health history, medications, surgery or other treatments
Key areas include biliary tract disease, alcohol use, and previous surgeries.
List some clinical problems associated with acute pancreatitis.
- Pain
- Fluid imbalance
- Electrolyte imbalance
- Nutritionally compromised
These problems require careful monitoring and management.
What are the overall goals for a patient with acute pancreatitis?
- Pain relief
- Normal fluid and electrolyte balance
- Minimal to no complications
- No recurrent attacks
These goals guide the nursing care and interventions.
What should be monitored during the acute care phase of pancreatitis?
Vital signs, fluid and electrolyte balance, response to IV fluids
Important indicators include hypotension, fever, and tachypnea.
What are some signs of respiratory distress in patients with severe acute pancreatitis?
Tachypnea, basilar crackles, decreased oxygen saturation
Regular monitoring of lung sounds and oxygen levels is crucial.
What are the symptoms of hypocalcemia to observe for in patients with acute pancreatitis?
Tetany, jerking, irritability, muscular twitching, numbness or tingling
Early signs include numbness around the lips and fingers.
What signs can indicate hypocalcemia in a patient?
Positive Chostek sign or Trousseau sign
These signs help in diagnosing hypocalcemia.
Fill in the blank: The patient with acute pancreatitis may need _______ to treat symptomatic hypocalcemia.
Calcium gluconate
This treatment is essential for managing low calcium levels.
What is a major focus of care in patients with acute pancreatitis?
Pain relief
Pain and restlessness can increase metabolic rate and contribute to hemodynamic instability.
Which medications may be used for pain relief in acute pancreatitis?
Opioids
Assess and document the duration of pain relief.
What position may help decrease pain in patients with acute pancreatitis?
Side-lying position with head elevated 45 degrees
This position decreases tension on the abdomen.
What care should be provided for patients on NPO status or with an NG tube?
Frequent oral and nasal care
This helps relieve dryness and prevent parotitis.
What signs should be observed in a patient with acute pancreatitis?
Fever and other signs of infection
Respiratory tract infections are common.
What measures can help prevent respiratory tract infections in patients with acute pancreatitis?
Turning, coughing, deep breathing, and assuming a semi-Fowlers position
These measures encourage better respiratory function.
What should be assessed to determine damage to the ß cells of the pancreas?
Blood glucose level
This assessment is crucial in acute pancreatitis.
What special care may be needed for patients who had surgery for acute pancreatitis?
Wound care for anastomotic leak or fistula
Use skin barriers and pouching to protect the skin.
What follow-up care may be needed after acute pancreatitis?
Home care follow-up and physical therapy
Important due to loss of physical and muscle strength.
What should patients with a history of acute pancreatitis avoid to prevent future attacks?
Alcohol and smoking
Counseling about abstinence is important.
What dietary changes should be taught to patients recovering from acute pancreatitis?
Fat restriction and increased carbohydrates
Fats stimulate cholecystokinin secretion, affecting the pancreas.
What are the expected outcomes for a patient with acute pancreatitis?
Adequate pain control, fluid balance, knowledge of treatment plan, help for alcohol use
These outcomes ensure recovery and management.
What characterizes chronic pancreatitis?
Continuous, prolonged inflammatory and fibrosing process
The pancreas is progressively destroyed and replaced by fibrotic tissue.
What is the most common cause of nonobstructive chronic pancreatitis?
Chronic alcohol use
This leads to inflammation and sclerosis in the pancreas.
What can cause obstructive pancreatitis?
Inflammation of the sphincter of Oddi from gallstones
Cancer of the ampulla of Vater, duodenum, or pancreas can also cause this type.
What are common clinical manifestations of chronic pancreatitis?
Abdominal pain, malabsorption, weight loss, diabetes, steatorrhea
Pain may be described as heavy, gnawing, or cramp-like.
What complications can arise from chronic pancreatitis?
Pseudocyst formation, bile duct obstruction, pancreatic ascites, pancreatic cancer
These complications can significantly affect health.
What is a challenge in diagnosing chronic pancreatitis?
Confirming the diagnosis can be hard due to overlapping symptoms
Diagnosis relies on signs, symptoms, laboratory studies, and imaging.
What levels may be increased in pancreatic conditions?
Amylase and lipase levels, serum bilirubin, and alkaline phosphatase levels
Depending on the degree of pancreatic fibrosis, amylase and lipase levels may be slightly increased or not at all.
What imaging studies can visualize changes in the pancreas?
CT, MRI, MRCP, and abdominal ultrasound
These imaging studies can show calcifications, ductal dilation, pseudocysts, and pancreas enlargement.
What is the purpose of a secretin stimulation test?
To assess the degree of pancreatic dysfunction.
What are the main focuses of care for chronic pancreatitis during an acute attack?
Identical therapy to that for acute pancreatitis.
What is a recommended diet for managing pancreatic insufficiency?
Small, bland, frequent meals that are low in fat.
What types of pancreatic enzyme products are used for enzyme replacement?
Pancrelipase, which contains amylase, lipase, and trypsin.
What are the fat-soluble vitamins that may require bile salts for absorption?
Vitamins A, D, E, and K.
What is the primary risk factor associated with pancreatic cancer?
Cigarette smoking.
What is the median age at diagnosis for pancreatic cancer?
Around 68 years of age.
What are common clinical manifestations of pancreatic cancer?
Abdominal pain, anorexia, rapid weight loss, nausea, and jaundice.
What imaging techniques are often used for diagnosing pancreatic cancer?
Abdominal ultrasound, EUS, spiral CT scan, ERCP, MRI, and MRCP.
What is the 5-year survival rate for pancreatic cancer?
Only 9%.
True or False: Most pancreatic tumors are adenocarcinomas.
True.
What is a choledochojejunostomy?
A surgical procedure that diverts bile around the ampulla of Vater.
Fill in the blank: The pain associated with pancreatic cancer often radiates to the _______.
Back.
What may indicate the effectiveness of pancreatic enzyme replacement therapy?
Monitoring stools for steatorrhea.
What types of medications may be used to control gastric acidity in pancreatic conditions?
Antacids, H2-receptor blockers, and PPIs.
What are common pain management options for chronic pancreatitis?
Analgesics such as morphine and fentanyl patch.
What is the consequence of smoking on chronic pancreatitis?
It can accelerate the progression of the disease.
What is an endoscopic ultrasound (EUS) used for?
Imaging the pancreas and allowing for fine-needle aspiration for biopsy.
What are pancreatic drainage procedures designed to relieve?
Ductal obstruction.
What is the most common disorder of the biliary system?
Cholelithiasis (stones in the gallbladder)
Cholelithiasis may lead to complications such as cholecystitis.
What is cholecystitis?
Inflammation of the gallbladder wall, usually associated with gallstones
Cholecystitis can be acute or chronic.
What percentage of American adults have cholecystitis caused by gallstones?
Up to 10%
Many individuals with gallstones may be asymptomatic.
What is cholecystectomy?
Removal of the gallbladder
It is one of the most common surgeries performed in the United States.
Which demographic is more likely to develop gallstones?
Women, especially multiparous women and women over 40 years of age
Factors such as estrogen replacement therapy and oral contraceptives increase risk.
What lifestyle factors increase the risk of gallbladder disease?
- Sedentary lifestyle
- Familial tendency
- Obesity
Obesity leads to increased secretion of cholesterol in bile.
What is the prognosis for a patient with pancreatic cancer?
Poor
Prognosis often requires the patient and caregiver to cope effectively.
What is the most commonly used tumor marker for pancreatic cancer?
Cancer-associated antigen 19-9 (CA 19-9)
CA 19-9 can also be elevated in other conditions such as gallbladder cancer and pancreatitis.
What percentage of patients have resectable tumors at the time of pancreatic cancer diagnosis?
15% to 20%
Neoadjuvant chemotherapy can increase the number of surgical candidates.
What is the Whipple procedure?
A surgical procedure involving resection of the proximal pancreas, duodenum, distal common bile duct, and distal stomach
It is performed for pancreatic head tumors.
What are the potential outcomes of a total pancreatectomy?
Causes diabetes and requires lifelong insulin therapy and pancreatic enzyme supplements
It is a last resort if the tumor cannot be surgically removed.
True or False: Radiation therapy alone has a significant effect on survival for pancreatic cancer.
False
Radiation may help with pain relief but not survival.
Fill in the blank: The symptoms of pancreatic cancer include _______.
anorexia, nausea, vomiting
Symptomatic and supportive care is crucial for patient management.
What measures are included in nursing management for pancreatic cancer patients?
- Symptomatic care
- Pain relief
- Nutritional support
- Psychologic support
Frequent and supplemental feedings may be necessary.
What is the role of chemotherapy in pancreatic cancer?
Limited and can have significant side effects
Common agents include fluorouracil and gemcitabine, among others.
What is the incidence of cholelithiasis in men compared to women?
Lower in men
Women are at increased risk due to factors such as pregnancy and estrogen replacement therapy.
What conditions increase the risk of cholelithiasis in women?
- Pregnancy
- Estrogen replacement therapy
- Obesity
Obesity particularly increases the risk for women.
What are the main components of gallstones?
- Cholesterol
- Bile salts
- Calcium
- Bilirubin
- Protein
Mixed cholesterol stones are the most common type of gallstones.
What leads to the formation of gallstones?
Changes in the balance of cholesterol, bile salts, and calcium in solution
This can result in precipitation of these substances.
What is lithogenic bile?
Bile that is supersaturated with cholesterol
This can contribute to the formation of gallstones.
What can cause bile stasis?
- Immobility
- Pregnancy
- Inflammatory lesions
- Obstructive lesions
These factors decrease bile flow and can lead to gallstone formation.
What is cholecystitis?
Inflammation of the gallbladder, often associated with obstruction caused by gallstones
Acalculous cholecystitis occurs without obstruction.
What are the common causes of acalculous cholecystitis?
- Prolonged immobility
- Fasting
- Prolonged PN
- Diabetes
Bile stasis is thought to be the main cause.
What are the symptoms of cholecystitis?
- Indigestion
- Acute pain
- RUQ tenderness
- Nausea and vomiting
- Fever
- Chills
- Jaundice
Symptoms can vary from mild to severe.
What is biliary colic?
Severe pain caused by gallstones moving through the ducts
The pain is rarely colicky and is often steady.
What happens if the common bile duct is obstructed?
No bilirubin reaches the small intestine, leading to dark amber to brown urine
This occurs because bilirubin is excreted by the kidneys.
What are some complications of gallstones and cholecystitis?
- Gangrenous cholecystitis
- Subphrenic abscess
- Pancreatitis
- Cholangitis
These complications can arise from untreated gallstones.
What physical findings are associated with acute cholecystitis?
- RUQ or epigastrium tenderness
- Abdominal rigidity
- Leukocytosis
- Fever
These findings are indicative of inflammation.
Fill in the blank: The main cause of acalculous cholecystitis is _______.
bile stasis
True or False: The pain from gallstones is typically colicky.
False
The pain is more often steady than colicky.
What can cause the gallbladder to become distended?
- Bile
- Pus
This occurs during an acute attack of cholecystitis.
What is the role of cholecystokinin in gallbladder function?
It induces gallbladder contraction
Absence of oral feeding can decrease or halt this contraction.
What are the manifestations of obstructed bile flow?
- Bleeding tendencies
- Clay-colored stools
- Dark amber to brown urine, which foams when shaken
- Fever and chills
- Intolerance for fatty foods
- Jaundice
- Pruritus
- Steatorrhea
- Urobilinogen absent in urine
These manifestations indicate various complications related to bile obstruction.
What causes bleeding tendencies in obstructed bile flow?
Lack of or impaired Vitamin K absorption, resulting in decreased prothrombin production.
Vitamin K is essential for blood clotting.
What causes clay-colored stools?
No bilirubin reaching the small intestine to be converted to urobilinogen.
Bilirubin is responsible for the brown color of normal stools.
What does dark amber to brown urine indicate in obstructed bile flow?
Water-soluble (conjugated) bilirubin elimination in urine.
This occurs due to the accumulation of bilirubin in the bloodstream.
What is a common complication of choledocholithiasis?
Symptoms of obstruction due to stones in the common bile duct.
Choledocholithiasis can lead to significant digestive issues.
What diagnostic study is often used to diagnose gallstones?
Ultrasound.
It is particularly useful for patients with jaundice.
What does ERCP allow for in the diagnosis of biliary conditions?
Visualization of the gallbladder, cystic duct, common hepatic duct, and common bile duct.
It is used to identify possible infecting organisms by culturing bile.
What is percutaneous transhepatic cholangiography?
Insertion of a needle directly into the gallbladder duct followed by injection of contrast materials.
It is usually done after ultrasound shows a bile duct blockage.
What laboratory tests may indicate an obstructive process?
- Increased WBC count
- Increased serum enzymes (alkaline phosphatase, ALT, AST)
- Increased direct and indirect bilirubin levels
- Increased urinary bilirubin levels
These tests help confirm the diagnosis of obstruction.
What is the treatment of choice for symptomatic gallstones?
Cholecystectomy.
This surgical procedure is commonly performed laparoscopically.
What are bile acids used for in gallstone treatment?
To dissolve stones, such as ursodiol and chenodiol.
However, gallstones may recur after treatment.
What is the role of ERCP with endoscopic sphincterotomy?
To remove stones from the biliary system.
This procedure allows for dilation and placement of stents.
What is extracorporeal shock-wave lithotripsy (ESWL)?
A treatment that uses high-energy shock waves to disintegrate gallstones.
It usually takes 1 to 2 hours for the stones to disintegrate.
What does treatment for acute cholecystitis focus on?
- Pain control
- Control of infection with antibiotics
- Maintaining fluid and electrolyte balance
Supportive care is crucial during an acute episode.
What is a cholecystostomy used for?
To drain purulent material from the obstructed gallbladder.
This procedure helps relieve symptoms and prevent complications.
What percentage of cholecystectomies are performed laparoscopically?
About 90%.
Laparoscopic cholecystectomy is minimally invasive and has quicker recovery times.
What is the diagnostic assessment for cholelithiasis and acute cholecystitis?
• History and physical assessment
• Ultrasound
• ERCP
• Percutaneous transhepatic cholangiography
• Liver function tests
• WBC count
• Serum bilirubin
What conservative therapy is recommended for patients with cholelithiasis?
• IN fluid
• NPO with NG tube, later progressing to low-fat diet
• Antiemetics
• Analgesics
• Fat-soluble vitamins (A, D, E, and K)
• Anticholinergics (antispasmodics)
• Antibiotics (for secondary infection)
• Transhepatic biliary catheter
• ERCP with sphincterotomy (papillotomy)
• Extracorporeal shock-wave lithotripsy
What are the two types of surgical therapy for gallbladder removal?
• Laparoscopic cholecystectomy
• Incisional (open) cholecystectomy
What is the main complication associated with laparoscopic cholecystectomy?
Injury to the common bile duct
What are the contraindications for laparoscopic cholecystectomy?
• Peritonitis
• Cholangitis
• Gangrene or perforation of the gallbladder
• Portal hypertension
• Serious bleeding disorders
Describe the procedure of laparoscopic cholecystectomy.
The HCP makes a small cut below the umbilicus, inserts a needle, inflates the abdomen with CO2, and uses a laparoscope with a camera and grasping forceps to remove the gallbladder.
What is the purpose of a T tube in gallbladder surgery?
Keeps the duct patent until edema subsides and allows excess bile to drain
What is the function of a transhepatic biliary catheter?
Decompress obstructed extrahepatic bile ducts to allow bile flow when endoscopic drainage fails.
What are the common drugs used in the treatment of gallbladder disease?
• Analgesics
• Anticholinergics (antispasmodics)
• Fat-soluble vitamins
• Bile salts
Fill in the blank: After a laparoscopic cholecystectomy, the patient should have _______ for the rest of the day.
liquids
What dietary recommendations can help reduce gallbladder problems?
• Smaller, more frequent meals with some fat
• Low in saturated fats
• High in fiber and calcium
• Avoid rapid weight loss
What should patients do to manage fluid loss from a transhepatic biliary catheter?
Replace lost fluids with electrolyte-rich drinks.
What signs should be observed for in patients with a transhepatic biliary catheter?
• Bile leakage at the insertion site
• Sudden abdominal pain
• Nausea
• Fever
• Chills
True or False: Patients can usually resume normal activities and return to work within 1 week after laparoscopic cholecystectomy.
True
What is the role of bile salts in gallbladder disease treatment?
Help with digestion and vitamin absorption.
What are important health history factors for cholecystitis or cholelithiasis?
Obesity, multiparity, infection, cancer, extensive fasting, pregnancy
These factors can increase the risk of developing gallbladder diseases.
Which medications are associated with cholecystitis or cholelithiasis?
Estrogen or oral contraceptives
Hormonal medications can influence gallbladder function.
What are some functional health patterns related to gallbladder disease?
- Positive family history
- Sedentary lifestyle
- Weight loss
- Anorexia
- Indigestion
- Fat intolerance
- Nausea and vomiting
- Dyspepsia
- Chills
These patterns can indicate the presence and severity of gallbladder issues.
What are common elimination symptoms in patients with gallbladder disease?
- Clay-colored stools
- Steatorrhea
- Flatulence
- Dark urine
These symptoms are indicative of bile flow issues.
What are the cognitive-perceptual symptoms of cholecystitis?
Moderate to severe RUQ pain that may radiate to the back or scapula, itching
Pain and itching are common complaints in gallbladder disease.
What objective cardiovascular symptom might indicate gallbladder disease?
Tachycardia
Elevated heart rate can be a response to pain or infection.
What GI symptoms might be observed in a patient with gallbladder disease?
Palpable gallbladder, abdominal guarding, distention
These signs indicate physical changes in the abdomen due to gallbladder issues.
What general symptoms may be present in cases of gallbladder disease?
Fever, restlessness
These symptoms often accompany infections or inflammatory processes.
What respiratory symptoms may indicate complications in gallbladder disease?
Tachypnea, splinting during respirations
These signs can indicate discomfort or pain affecting breathing.
What skin symptoms are associated with gallbladder disease?
Jaundice, icteric sclera, diaphoresis
Yellowing of the skin and eyes indicates bile duct obstruction.
What are possible diagnostic findings in gallbladder disease?
- Elevated serum liver enzymes
- Alkaline phosphatase
- Bilirubin
- Absence of urobilinogen in urine
- Elevated urinary bilirubin
- Leukocytosis
- Abnormal gallbladder ultrasound
These findings help confirm the diagnosis of gallbladder issues.
What dietary modifications may be needed after an incisional cholecystectomy?
Progress from liquids to a regular diet based on fat tolerance
A low-fat diet may be necessary initially or for overweight patients.
What are the overall goals for a patient with gallbladder disease?
- Relief of pain and discomfort
- No complications
- No recurrent attacks of cholecystitis or gallstones
These goals guide nursing management and patient care.
What should be monitored in patients receiving conservative therapy for gallbladder disease?
- Pain management
- Nausea and vomiting relief
- Fluid and electrolyte balance
- Nutrition
- Complications
Ongoing assessment is crucial to prevent further issues.
True or False: Patients with chronic cholecystitis often present with acute symptoms.
False
Chronic cases may not show symptoms until complications arise.
What nursing interventions are appropriate for managing nausea and vomiting in gallbladder disease?
- NG tube and gastric decompression
- Anti-emetics for less severe cases
- Frequent mouth rinses
- Oral hygiene
These measures help maintain patient comfort and prevent further complications.
What signs may indicate obstruction of the ducts by stones?
- Jaundice
- Clay-colored stools
- Dark, foamy urine
- Steatorrhea
These manifestations signal the need for immediate medical evaluation.
What complications should be assessed for after ERCP with papillotomy?
- Pancreatitis
- Perforation
- Infection
- Bleeding
Monitoring vital signs and symptoms is crucial in the postoperative phase.
What are important health history factors for cholecystitis or cholelithiasis?
Obesity, multiparity, infection, cancer, extensive fasting, pregnancy
These factors can increase the risk of developing gallbladder diseases.
Which medications are associated with cholecystitis or cholelithiasis?
Estrogen or oral contraceptives
Hormonal medications can influence gallbladder function.
What are some functional health patterns related to gallbladder disease?
- Positive family history
- Sedentary lifestyle
- Weight loss
- Anorexia
- Indigestion
- Fat intolerance
- Nausea and vomiting
- Dyspepsia
- Chills
These patterns can indicate the presence and severity of gallbladder issues.
What are common elimination symptoms in patients with gallbladder disease?
- Clay-colored stools
- Steatorrhea
- Flatulence
- Dark urine
These symptoms are indicative of bile flow issues.
What are the cognitive-perceptual symptoms of cholecystitis?
Moderate to severe RUQ pain that may radiate to the back or scapula, itching
Pain and itching are common complaints in gallbladder disease.
What objective cardiovascular symptom might indicate gallbladder disease?
Tachycardia
Elevated heart rate can be a response to pain or infection.
What GI symptoms might be observed in a patient with gallbladder disease?
Palpable gallbladder, abdominal guarding, distention
These signs indicate physical changes in the abdomen due to gallbladder issues.
What general symptoms may be present in cases of gallbladder disease?
Fever, restlessness
These symptoms often accompany infections or inflammatory processes.
What respiratory symptoms may indicate complications in gallbladder disease?
Tachypnea, splinting during respirations
These signs can indicate discomfort or pain affecting breathing.
What skin symptoms are associated with gallbladder disease?
Jaundice, icteric sclera, diaphoresis
Yellowing of the skin and eyes indicates bile duct obstruction.
What are possible diagnostic findings in gallbladder disease?
- Elevated serum liver enzymes
- Alkaline phosphatase
- Bilirubin
- Absence of urobilinogen in urine
- Elevated urinary bilirubin
- Leukocytosis
- Abnormal gallbladder ultrasound
These findings help confirm the diagnosis of gallbladder issues.
What dietary modifications may be needed after an incisional cholecystectomy?
Progress from liquids to a regular diet based on fat tolerance
A low-fat diet may be necessary initially or for overweight patients.
What are the overall goals for a patient with gallbladder disease?
- Relief of pain and discomfort
- No complications
- No recurrent attacks of cholecystitis or gallstones
These goals guide nursing management and patient care.
What should be monitored in patients receiving conservative therapy for gallbladder disease?
- Pain management
- Nausea and vomiting relief
- Fluid and electrolyte balance
- Nutrition
- Complications
Ongoing assessment is crucial to prevent further issues.
True or False: Patients with chronic cholecystitis often present with acute symptoms.
False
Chronic cases may not show symptoms until complications arise.
What nursing interventions are appropriate for managing nausea and vomiting in gallbladder disease?
- NG tube and gastric decompression
- Anti-emetics for less severe cases
- Frequent mouth rinses
- Oral hygiene
These measures help maintain patient comfort and prevent further complications.
What signs may indicate obstruction of the ducts by stones?
- Jaundice
- Clay-colored stools
- Dark, foamy urine
- Steatorrhea
These manifestations signal the need for immediate medical evaluation.
What complications should be assessed for after ERCP with papillotomy?
- Pancreatitis
- Perforation
- Infection
- Bleeding
Monitoring vital signs and symptoms is crucial in the postoperative phase.
What should the patient do the day after a laparoscopic cholecystectomy regarding bandages?
Remove the bandages on the puncture sites
The patient can shower after removing the bandages.
What is a common referred pain after laparoscopic cholecystectomy?
Referred pain to the shoulder
This is due to CO2 used to inflate the abdominal cavity.
What symptoms should prompt a patient to notify their healthcare provider after surgery?
- Redness, swelling, bile-colored drainage or pus from any incision
- Severe abdominal pain, nausea, vomiting, fever, chills
When can a patient typically return to work after a laparoscopic cholecystectomy?
Within 1 week of surgery.
What dietary change may patients need to make after laparoscopic cholecystectomy?
Many tolerate a low-fat diet better for several weeks after surgery.
What is the incidence rate of gallbladder cancer in women in the United States?
1.4 per 100,000.
What is the most common type of gallbladder cancer?
Adenocarcinomas.
What are early symptoms of gallbladder cancer similar to?
Chronic cholecystitis and gallstones.
What is a common treatment option for gallbladder cancer when surgery is not feasible?
Endoscopic stenting of the biliary tract.
What factors influence the successful surgical outcomes for gallbladder cancer?
- Depth of cancer invasion
- Extent of liver involvement
- Venous or lymphatic invasion
- Lymph node metastasis
What should patients avoid doing for 4 to 6 weeks after an incisional cholecystectomy?
Heavy lifting.
What type of diet is usually recommended for patients with gallbladder cancer?
Low in fat.
What is the prognosis for gallbladder cancer?
Overall, gallbladder cancer has a poor prognosis.
True or False: Most patients with gallbladder cancer are symptomatic at diagnosis.
False.
What should nursing management for gallbladder cancer focus on?
Palliative care with special attention to nutrition, hydration, skin care, and pain relief.
What imaging techniques are used for the diagnosis and staging of gallbladder cancer?
- EUS
- Abdominal ultrasound
- CT
- MRI
- MRCP
Fill in the blank: Patients may need to take _______ supplements if they have gallbladder cancer.
fat-soluble vitamin
What should patients with gallbladder cancer be taught regarding health care follow-up?
The importance of continued health care follow-up.
